A patient in his 20s recently came to see me in a state of severe distress. He described feeling consumed by his thoughts, constantly anxious, unable to function, and deeply exhausted. His sleep had collapsed. His sense of identity felt lost. He was experiencing persistent passive suicidal thoughts, not because he wanted to die, but because everything felt overwhelming and unrelenting.

Within three days of starting low-dose lithium at 150 milligrams …

Read more…

When my father-in-law died by suicide, our family did not just lose a person. We lost the gravitational center of a small universe.

He was a giant in my eyes. Not because of his curriculum vitae, though his was extraordinary, but because of the way he moved through the world: steady, modest, and relentlessly devoted to the people who needed him.

He had survived what should have broken a human being. As …

Read more…

Over the past decade, there has been a marked rise in adolescents and adults seeking autism evaluations. Many of these individuals are intellectually intact, verbally fluent, and professionally capable, yet have lived for decades with persistent social fatigue, sensory sensitivities, difficulty interpreting unspoken social rules, emotional overwhelm, rigid or all-or-nothing thinking, challenges with transitions, and extensive masking or camouflaging behaviors, all without a diagnosis. When they finally seek clarity, the …

Read more…

I began my career as a nurse practitioner in primary care, where patient visits are often limited to 15 or 20 minutes to manage complex conditions like hypertension, diabetes, and COPD. What struck me was how often these medical issues came with a psychological overlay like depression, anxiety, panic attacks, and trauma. That shaped the course of treatment as much as lab results or medications. The pace of primary care …

Read more…

When I received an invitation to a webinar titled “Special Session on a New Autism Risk Test,” I expected a discussion on screening strategies or intervention innovations. Instead, when I researched the company and reviewed its website, I discovered a pitch for a punch-biopsy-based lab test marketed as a way to detect autism risk in newborns as early as two days after birth.

As a nurse practitioner who treats autistic patients, …

Read more…